Senior Analyst, Part D Spend

Clover Health

1d•$115,000 - $133,000•Remote

About The Position

Our Part D organization is focused on optimizing pharmacy spend while improving clinical outcomes for Clover Health’s Medicare members. The analytics team plays a critical role in ensuring that clinical management programs are measurable, scalable, and effective in driving both cost and quality performance. We're looking for a Senior Analyst to own end-to-end analytics for Part D Spend performance and clinical engagement programs. You'll sit at the intersection of data, clinical strategy, and operations — ensuring that insights aren't just accurate and scalable, but actionable and embedded in the workflows that drive real health outcomes and cost optimization.

Requirements

4–6+ years of experience in healthcare analytics, with direct exposure to Part D / pharmacy data, clinical data and sources for appropriate therapeutic substitutions.
Proficient in SQL and experienced building, validating, and QA-ing complex datasets across claims, pharmacy, eligibility, clinical documentation, and vendor sources.
Performed both backend data QA and business-facing analytics, and can connect findings to program performance and operational decisions.
Experience evaluating interventions, clinical programs, or vendor performance using structured measurement frameworks.
Familiar with clinical best practices, regulatory and commercially available data sets (e.g., FDB, RxNorm, MediSpan, FDA), regulatory requirements, and can work within BI tools like Tableau, Looker, Power BI, or Mode.
Communicate clearly across technical and non-technical audiences and can translate complex data into actionable insights for stakeholders at all levels.

Nice To Haves

Experience with specialty pharmacy or pharmacogenomics programs
Exposure to provider-facing tools (e.g., EHRs)
Experience in value-based care or cost-of-care analytics

Responsibilities

Own Part D clinical engagement and spend analytics end-to-end. Serve as the single-threaded owner for clinical management program performance, tracking KPIs and ROI for pharmacy spend optimization — ensuring outputs directly inform interventions, provider actions, and business decisions.
Build and maintain data infrastructure. Design, optimize, and QA SQL-based pipelines and datasets across claims, pharmacy, and vendor sources. Partner with Data Engineering on architecture, automation, and documentation aligned to CMS (Centers for Medicare and Medicaid Services), PQA (Pharmacy Quality Alliance), and internal standards.
Generate and communicate insights. Analyze Part D performance and clinical interventions to identify trends, gaps, and early warning signals. Conduct root cause analyses across adherence, prescribing behavior, and specialty drug utilization. Translate findings into clear recommendations and build dashboards that support both operational and executive decision-making.
Evaluate programs and vendors. Design test-and-learn frameworks to assess the effectiveness of pharmacy interventions, clinical programs, and vendor initiatives. Define success metrics, run cohort analyses, and apply learnings to future improvements.
Enable cross-functional partners. Act as the primary analytics partner for Part D spend management operations and vendor teams. Bridge business needs to technical teams, and partner with Product and Engineering to integrate insights into Counterpart Assistant and provider workflows.
Build operational structure. Establish standardized analytics workflows, SOPs, and intake processes. Drive consistent use of measure logic and business rules across teams to support a scalable performance management cadence.
Drive technology and automation. Support initiatives to improve prescribing interoperability, real-time visibility, and automation of intervention tracking and performance monitoring.